Provider Demographics
NPI:1356123095
Name:WILBURN, TREVOR L
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:L
Last Name:WILBURN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4179 STATE HIGHWAY 87 S
Mailing Address - Street 2:
Mailing Address - City:CENTER
Mailing Address - State:TX
Mailing Address - Zip Code:75935-5508
Mailing Address - Country:US
Mailing Address - Phone:936-427-0870
Mailing Address - Fax:
Practice Address - Street 1:4179 STATE HIGHWAY 87 S
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:TX
Practice Address - Zip Code:75935-5508
Practice Address - Country:US
Practice Address - Phone:936-427-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No343800000XTransportation ServicesSecured Medical Transport (VAN)